Provider Demographics
NPI:1467530410
Name:PURCELL, HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:PURCELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 797021
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-7000
Mailing Address - Country:US
Mailing Address - Phone:314-644-3535
Mailing Address - Fax:314-644-3255
Practice Address - Street 1:6812 STATE ROUTE 162 STE 121
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8586
Practice Address - Country:US
Practice Address - Phone:618-391-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9H62207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110165961OtherRAILROAD MEDICARE
ILK47039Medicare PIN
MOE44179Medicare UPIN
MO002014286Medicare PIN